Arthroscopic Meniscus Ramp Repair: The Shoelace Technique

Area of Science:

• Orthopedic Surgery
• Knee Arthroscopy
• Meniscal Repair

Background:

• Ramp lesions, injuries at the peripheral attachment of the medial meniscus posterior horn, are linked to anterior cruciate ligament (ACL) load and knee instability.
• Undiagnosed ramp lesions during ACL reconstruction can compromise graft integrity and lead to residual instability.
• These lesions present treatment challenges due to misdiagnosis and complex surgical learning curves.

Purpose of the Study:

• To present a novel arthroscopic technique for repairing large ramp lesions.
• To describe the margin convergence shoelace technique for effective ramp lesion repair.
• To highlight the benefits of this technique in improving knee stability and reducing graft failure.

Main Methods:

• Arthroscopic visualization of the posteromedial compartment using the Gillquist maneuver.
• Creation of dual low and high posteromedial portals for optimal access and visualization.
• Repair of the ramp lesion using a margin convergence shoelace technique with fiber wire sutures.

Main Results:

• The described shoelace technique facilitates good healing of ramp lesions.
• Knee stability is effectively restored following the repair.
• Follow-up exceeding two years demonstrates improved functional outcomes and lower retear rates.

Conclusions:

• The arthroscopic shoelace technique with dual posteromedial portals is a safe, easy, and cost-effective method for ramp lesion repair.
• This technique yields excellent results, particularly for larger meniscal tears.
• It offers a valuable alternative for addressing challenging ramp lesions, enhancing patient outcomes.